Improving the diagnosis and treatment of glaucoma worldwide

Drs. Friedman, Ramulu, and Quigley

Project 1: Angle closure glaucoma is a leading cause of blindness worldwide with limited evidence supporting current treatments. The team will:

Continue an ongoing study of laser iridotomy to prevent angle closure glaucoma in persons at risk. This study being conducted in Guangzhou, China is the largest clinical trial in this field and has been underway for over two years with close to 1,000 participants being followed. It has an international collaborative advisory committee consisting of members from University College, London, from Singapore, and from China. Funding for additional follow-up will be required and we estimate the total cost to fully fund this effort at $500,000.

Expand work with our collaborators at Singapore National Eye Center to define more clearly the mechanisms of angle closure and to prospectively monitor outcomes in persons with different underlying mechanisms. During the past 5 years, our research in this program has developed an important new diagnostic approach using anterior segment optical coherence tomography, whose prototype instrument and design modifications depended on our group. The collaboration of Dr David Silver of Wilmer and the Applied Physics Lab have been vital in this work. A longitudinal followup cohort is now being assembled to validate whether diagnostic risk factors that have been developed will be validated prospectively. The additional funding needed to monitor this group is estimated at $250,000.

Project 2: Glaucoma care in the developing world is limited and most patients are diagnosed only when the disease has led to severe vision loss. Identifying ways to integrate glaucoma care into the care of patients in these regions will be a key component of preventing glaucoma related blindness.

The GCE will establish ongoing training opportunities at Wilmer for ophthalmologists at large institutions in the developing world in order to improve the management of glaucoma in their environment. Collaboration with the School of Public Health, including Kay Dickersin are important to this work. Funding for this will require $30,000 per person trained and equipped, plus equipment costs.

The GCE will actively engage in producing models of screening for and detecting glaucoma in hospitals that are already seeing a high volume of patients in the developing world. Currently these patients are largely undiagnosed or treated ineffectively. This research effort will likely start in India with colleagues at the Aravind Eye Hospital and will be expanded to other regions as a clear model is developed. The cost to initiate this process is $50,000.